Fig. 1

A: High-quality clinical reasoning documentation by academic year (AY) demonstrating a decline AY 2019–2020 driven by notes authored during the peak of the initial COVID-19 surge in New York City (March to June 2020). B: High-quality clinical Reasoning documentation by shift and hour demonstrating notes written during the night shift were more likely to be high-quality than those in the day shift and notes written later in the night shift appeared associated with lower note quality but this relationship disappeared in the multivariable regression. C: High-quality clinical reasoning documentation by note index within shift demonstrating that within each shift every additional note (i.e., higher note index) was associated with lower quality clinical reasoning documentation